This is a unique case of a patient aged 35 years developing rheumatic carditis secondary to acute rheumatic fever. The patient developed acute mitral regurgitation yet tolerated it relatively well because of coexistent Tetralogy of Fallot. The hemodynamics in this patient was significantly altered by the coexistence of these two conditions. This is the first case of its kind when acute rheumatic fever has been documented in a patient of Tetralogy of Fallot.
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